P - 83552I�IIfI��IIIII�I�III�III�Illlll�lll�ll�lllll�l�llll R82�1 UEiSersFORve.LRm. SR1C8, St PaPEMNION04 ���,��
Minnesota State Board of Electricity �
��* 0 3 9 2 3 3 8 0* Phone (612) 642-0800 ���� %�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspectian Request will not be accqoted without the carect fee:
Other Fee u Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. � 50
Alarm/Remote Control
SWifTlfTling POOI I hereby certify that I inspected the electrical installatan described herein on the dates stated
Irrigation Boom Rough-In Date
X Special inspection 1. 50
Final Date
Investigative F r'' °l :'� � — '- %
THIS INSTALLATION A ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-• � _ __ -----�- - ----�__-•--� - - ---._._.�_.....�__.,.._.,
OFFICE USE ONLY This rr,�quest void 18 months from validation date printed in this box.
392-33� ��S �(� / ��'
JOB NUMBER #�06000
PLEASE PRINT OR TYPE
Requeft �atf �0 � 98 Rough-in inspection required? ❑ Yes �Oo Inspedion Other Than Rough-In: [K Ready Now ❑ Will Call
(You must call the inspecta when ready) Date Ready: 11 I 30I 98
I, �j licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zjp Cpde
07501 JACKSON ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JOSE A COLOH 784-9030
Power Supplier Address
NSF MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Nlaster Lic. No. (Plant Elect. Ony)
MASTEf2 ELECTRIC CO. , INC. �A@1192
Mailing Address (Contractor or Owner Performing Installation)
1246'7 BCJON� AYE S. SAVAGE M. 55378
Authorized Signature (Contractor or Owner Performing Installation) �, '� r� C �� Phone No.
941 47121890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INS7RUCTIONS ON BACK OF YELLOW COPY